Are Health Insurance Marketplace plans better for Ryan White clients?
by Morénike Giwa Onaiwu
Five weeks after young AIDS activist Ryan White died of AIDS-related causes in 1990, the historic HIV/AIDS program named in his honor was enacted. More than 20 years after his death, the Ryan White Program continues to be a lifeline for more than half a million low-income HIV-positive Americans.
Here in Texas, where we have approximately 73,000 individuals living with HIV, nearly 60,000 clients access Ryan White services annually. Services range from medication assistance programs to primary medical care, transportation, food banks, mental health, legal services, and more. These services are offered by a vast network of providers, many of whom are well established in their communities and have been caring for adults, infants, and children with HIV for a number of years.
However, the implementation of the Affordable Care Act (ACA) has changed the way HIV care works for HIV-positive Texans—particularly those who are accustomed to receiving care through the Ryan White program. This is happening quickly throughout our state, and there are very mixed emotions about these changes in the HIV community.
Laura is a small woman with a big presence. Like many people living with HIV in her native Houston, she is a person of color. A widowed mother, Laura works part-time and attends college full-time. She was able to obtain healthcare coverage through the federal ACA Marketplace website. But then as Laura began to work with her case manager to transition into coverage, she grew concerned. “Ryan White helps pay my premiums,” Laura says, referring to the recent allocation of Ryan White dollars to assist with paying clinets’ insurance premiums and co-pays. Laura fears that this burden on Ryan White funds is not sustainable. “I worry about the future,” she says. “I went back to school to make things better for my daughter, but I must have access to healthcare in order to provide a better life for us.”
Willie, another Ryan White client, is more optimistic about Ryan White patients transitioning into Health Insurance Marketplace plans. In addition to HIV, Willie has other health conditions that require treatment.
With his prior coverage, his insurance premiums (before the enactment of the ACA) totaled more than $1,800 per month. Willie now has a health insurance plan through the Marketplace, and his premium dropped to under $200. Both Willie and Laura receive medical care at Legacy Community Health Services.
Reports of such tremendous financial savings among those who have enrolled in the Marketplace are astonishing. But the cost to the Texas Ryan White AIDS Drug Assistance Program (ADAP), which provides lifesaving antiretroviral medication to over 13,000 low-income HIV-positive Texans each year, is exorbitantly higher. Another disturbing fact is that at least 65 percent of people receiving ADAP meet the criteria for our state’s nonexistent Medicaid expansion.
There is more involved in quality HIV treatment than medication, and Ryan White funding allows for the provision of a number of supportive and wraparound services that are criticalfor optimal health and viral suppression.
Ryan White services still fill a number of crucial gaps that exist—even with the expanded benefits provided by the ACA. State HIV advocates are well aware that there is ambivalence in the community regarding Ryan White and the ACA. To address this, organizations such as the Ryan White Planning Council exist to share resources, answer questions, and dispel misconceptions.
In Houston, a health insurance enrollment study is currently being conducted with consumers about their experiences with the Health Insurance Marketplace. The state has also launched an insurance assistance pilot program for HIV-positive consumers. Hopefully, through this information, processes can be improved in order to better address the needs of HIV-positive Texans as they transition to the Marketplace.
Emphasizing that HIV is still a serious public health issue, many are embracingthe changes brought about by the ACA. The Houston Ryan White Planning Council, for example, asserts that the ACA is an historic opportunity for all Americans, including people living with HIV/AIDS and those receiving services through the Ryan White Program, to increase their access to affordable, quality healthcare. Many Ryan White clients will gain access to health insurance or see their current health insurance improve as a result of the ACA.
Others are less optimistic, but have opted to reserve their judgment until more time has passed. They realize the importance of community involvement and the need for increased transparency during these initial years of implementing the ACA.
While the verdict is still out on ACA as a whole, the Ryan White program’s active role in increasing access to the ACA, and increasing awareness of its provisions, is a tribute not only to its continuing importance in these first few uncertain ACA years, but is also a tribute to its powerful legacy.
Morénike Giwa Onaiwu is a passionate Houston and national advocate and activist for the HIV/AIDS community. She is a past chair of the Houston Ryan White Planning Council, and currently sits on the Comprehensive Planning committee. She has a master’s degree in special education with an emphasis in autism and developmental delays.